Seven of the 21 million Pakistanis affected by this summer’s floods are still without shelter, the United Nation’s Pakistan Office reported this week. And an estimated 14 million continue to need urgent humanitarian assistance.

These figures are an indictment of the Pakistan ruling elite’s incompetently organized and poorly funded flood relief effort.

They also are an indictment of the imperialist powers. Under conditions where Pakistan has faced what the UN has repeatedly described as the world’s largest humanitarian crisis in decades, the agency has repeatedly had to plead for the “international community” to come to assist Pakistan.

The western-dominated IMF and World Bank have tied flood aid to their demand for Pakistan to implement market reforms. Washington, meanwhile, has intensified its pressure on Pakistan to expand its counter-insurgency war against Taliban-aligned groups in the Federally Administered Tribal Areas.

Pakistan’s floods began with heavy rains in the country’s north-east in late July and continued as the water travelled the length of the Indus Valley over the next two months. More people were displaced in Sindh, the country’s southern-most province, than anywhere else, although authorities had weeks of warning about the impending floods. The vast majority of those now lacking shelter are from Sindh.

According to the Government of Pakistan’s National Disaster Management Authority the floods killed 1,961 people. But these figures could still rise sharply due to the spread of disease in relief camps, inadequate food aid, and the disruption of the country’s food supply.

At an Islamabad press conference called to release a “Floods in Pakistan Fact Update” October 18, UN spokeswoman Stacey Winston said, “At least seven million people are currently without shelter in the flood-affected areas.”

According to the report, the floods destroyed or damaged 1.9 million homes and ravaged public infrastructure in a 50,000 square kilometer area—an area larger than the Netherlands. About 10,000 schools and 558 health facilities have been severely damaged.

The UN has requested international donors provide $US346 million to provide flood victims with emergency shelter, such as tents, and transitional shelter mean to last several years while permanent housing can built. So far the UN has received only 20 percent of that sum.

“We are doing the best we can with what resources we have,” said Winston. But more support is needed for shelter to protect families during the winter months ahead.”

The fact sheet reported that the floods washed away at least 2.4 million hectares of standing crops and resulted in the deaths of 1.2 million livestock and 6 million poultry. “More,” it added, “may die without proper feed and veterinary support.”

Although the flood waters have receded, the UN report noted that acute health risks remain due to the unavailability of clean water, sanitation and basic health facilities.

Over the past two months, there have been more than a million cases each of diarrhea, skin disease, and acute respiratory infections. There have been an estimated 300,000 new cases of malaria and 921 confirmed dengue cases.

Another UN agency, the IRIN, reported that people are aware of many of the health threats but face overwhelming problems.

“We know malaria is a risk, but what are we expected to do when we have no roof to sleep under, no proper cots to tie nets to, and a situation where dirty water stands everywhere?,” Saghir Muhammad of Thatta in Sindh, who was displaced by floods, told the IRIN.

A government official in Thatta explained to the IRIN that there are no resources to drain away the pools of stagnant water left by the floods even though there are prime breeding grounds for the mosquitoes that transmit malaria: “Of course [the pools of stagnant] water should be drained away, but we have no equipment and it is not easy anyway to get rid of so much water.”

Other groups and agencies are warning of the threat of hunger and malnutrition.

The International Federation of Red Cross and Red Crescent Societies (IFRC) has said millions of flood victims could go hungry this winter. The secretary general of the IFRC, Bekele Geleta, pointed out that “unlike an earthquake, this is a slow onset disaster and the full effects may not be known for months to come.”

According to the IFRC, malnutrition has risen to 14 per cent across Pakistan and 30 to 50 percent of children arriving at health centres show symptoms of acute malnutrition.

UNICEF paints an even grimmer picture of the children affected by floods. 125,000 children under the age of 5 are severely malnourished and half a million more suffer from moderate malnutrition. It estimates that the 75,500 “severely” malnourished children are ten times more likely to die from disease than merely the malnourished.

The World Food Programme (WFP) warned, in a report issued last week, that severe and moderate malnutrition is “rising dramatically in some flood-affected areas.” “Sadly,” said WFP spokeswoman Jackie Dent, “we are getting low on funds and by November we have a pipeline break for several commodities.”

Three days prior to the UN announcement that 7 million people in Pakistan are still without shelter, the Friends of Democratic Pakistan (FoDP)—a grouping dominated by the US and European powers—met in Brussels.

The meeting, which was co-chaired by Pakistani Foreign Minister Shah Mehmood Qureshi, considered recent reports from the World Bank and Asian Development Bank that estimated the floods caused $9.7 billion in damages to houses, schools, crops and indirect future economic losses. This is a far cry from the Pakistan government’s initial estimate of $43 billion.

But even if the lower estimate is correct, it represents more than a quarter of Pakistan’s annual national budget.

Yet the scale of the disaster confronting the Pakistani people did not prevent the gathering from demanding “continued efforts by the Government of Pakistan under its reform programme towards economic stabilisation and sustained economic revival, including widening the tax base, and taking other necessary structural measures to generate and enhance the maximum possible term development.”

This is a demand for Islamabad to speed up implementation of an IMF restructuring program that calls for the government to phase out within the current fiscal year all subsidies on energy prices, otherwise cut government spending, and introduces a new value-added sales tax. The IMF has held up the last tranche in an $11.3 billion loan negotiated in the fall of 2008, insisting that the funds will only be released after these socially incendiary measures have been implemented by Islamabad.

With much fanfare, the Obama administration has pledged several hundreds of millions of dollars in flood aid to Pakistan. But it is taking this from monies already earmarked for Pakistan under a five-year aid plan adopted in 2009, the Kerry-Lugar bill. And Washington continues to balk at Islamabad’s longstanding plea for the US to reduce tariffs on Pakistan-made cotton goods, the country’s biggest export-earner.